Gout is associated with a number of important comorbidities, including chronic kidney disease, hypertension, cardiovascular disease, diabetes, and hyperlipidemia. These comorbidities and their treatment have a role in the development of gout as well as important implications for therapies used in the management of both gout flares and long-term urate lowering. Chronic kidney disease is one of the most common comorbidities and affects the use of nonsteroidal antiinflammatories and colchicine for gout flares. The use of urate-lowering therapies, both the agent and dose, in people with chronic kidney disease remains a controversial area. Drugs used in the management of hypertension and cardiovascular disease may have significant effects on serum urate, and where possible medications that do not contribute to hyperuricemia should be used in people with gout. The diagnosis of gout should alert the clinician to screen for and manage these common comorbidities.